PSYCHIATRIC EFFECTS OF ANABOLIC-ANDROGENIC STEROIDS (AAS) ON ATHLETES - A COMPREHENSIVE LITERATURE REVIEW

Carmena Luty; Maja Osuch; Maciej Osuch; Olga Tatarata; Martyna Jaciubek; Amanda Abramowicz; Magdalena Rumin; Anna Kiełboń; Zuzanna Olga Reklewska; Kornelia Domagała

doi:10.31435/ijitss.1(49).2026.5050

Authors

Carmena Luty 118th Military Hospital with Polyclinic SPZOZ in Ełk, Ełk, Poland https://orcid.org/0009-0007-6084-0385
Maja Osuch 4th Military Clinical Hospital with Polyclinic SPZOZ in Wrocław, Wrocław, Poland https://orcid.org/0009-0000-9815-2608
Maciej Osuch 4th Military Clinical Hospital with Polyclinic SPZOZ in Wrocław, Wrocław, Poland https://orcid.org/0009-0009-2399-2878
Olga Tatarata Military Institute of Aviation Medicine, Warsaw, Mazovia, Poland https://orcid.org/0009-0007-1279-7394
Martyna Jaciubek Military Institute of Aviation Medicine, Warsaw, Mazovia, Poland https://orcid.org/0009-0002-5520-0002
Amanda Abramowicz Military Institute of Aviation Medicine, Warsaw, Mazovia, Poland https://orcid.org/0009-0004-6674-0594
Magdalena Rumin Military Institute of Aviation Medicine, Warsaw, Mazovia, Poland https://orcid.org/0009-0009-4281-8971
Anna Kiełboń Military Institute of Medicine in Warsaw, Mazovia, Poland https://orcid.org/0009-0004-9028-6395
Zuzanna Olga Reklewska The Military Medical Training Center, Łódź, Poland https://orcid.org/0009-0008-3539-646X
Kornelia Domagała 7th Naval Hospital in Gdańsk, Gdańsk, Poland https://orcid.org/0009-0008-4148-9320

DOI:

https://doi.org/10.31435/ijitss.1(49).2026.5050

Keywords:

Anabolic-Androgenic Steroids, Athletes, Psychiatric Effects, Depression, Anxiety, Muscle Dysmorphia

Abstract

Background and Objectives: Anabolic-androgenic steroids (AAS) are synthetic derivatives of testosterone widely misused by athletes to enhance physical performance and appearance. Emerging evidence indicates substantial psychiatric morbidity associated with AAS use. This comprehensive literature review synthesizes empirical evidence from peer-reviewed research published between 2015 and 2025 examining psychiatric effects of AAS among athletic populations.

Methods: A systematic search of electronic databases (PubMed, Scopus, Web of Science, Google Scholar) was conducted using keywords related to AAS, psychiatric effects, mental health, and athletes. Studies published in English or Polish between January 2015 and December 2025 were included. Data extraction focused on prevalence, clinical manifestations, neurobiological mechanisms, and treatment implications.

Results: Recent epidemiological data indicate AAS prevalence of approximately 10–20% among elite athletes and over 25% among weightlifters, with rates exceeding 36% in some bodybuilding populations. Significant associations were identified between AAS use and depression (Beck Depression Inventory scores significantly elevated, p<0.001), anxiety disorders (Beck Anxiety Inventory scores p<0.001), aggression and violence (meta-analytic evidence of increased interpersonal violence risk), mania and psychosis (dose-dependent), muscle dysmorphia (prevalence 58% in some AAS-using samples vs. 2-6% general population), cognitive deficits (visuospatial memory p=0.004, executive function impairment), and dependence syndromes (affecting approximately 30% of users). Neuroimaging studies demonstrated structural brain changes including cortical thinning, altered amygdala volume, and reduced frontal connectivity. Withdrawal syndrome characterized by prolonged hypogonadism and severe depression may persist for months to years. Risk factors include body image disorders (r=0.24 with obsessive-compulsive traits), competitive pressure, and polysubstance use.

Conclusions: AAS use among athletes is associated with substantial psychiatric morbidity affecting mood, cognition, behavior, and brain structure. Evidence from 2015-2025 employing advanced methodologies (neuroimaging, network analysis, large-scale epidemiology) has substantially enhanced understanding. Integrated treatment approaches targeting substance use, psychiatric symptoms, and underlying body image pathology are essential. Future research priorities include longitudinal studies, gender-specific investigations, neurobiological mechanism elucidation, and evidence-based treatment trials.

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